Pulmonary edema how many are in intensive care

Hemorrhagic stroke What to do

My father of 1939 has been already a week in intensive care (should have been transferred to an ordinary ward but I agreed to leave in intensive care) after GI.

I wanted to transfer him to another medical institution, butwhen the price tag was announced, the desire immediately disappeared and this was motivated by the alleged law that if at the request of relatives the patient is transferred from one medical institution to another, then only at the commercial offices!?!?!?!

Therefore, the next question!

What to do. leave his father in an ordinary hospital (he will arrange for him to lie in the intensive care unit all the time), or pay round sums and transfer

as far as the treatment and drugs are understood the same!

And such a question as far as I understand the state of the critical after GI lasts 2 weeks or more?

After what period can I decide on the transfer to the rehabilitation center?

How long does the hematoma of the brain resolve?

Tell the hospital in Moscow with a good neurological department

And more gentlemen: please tell me where there are good rehabilitation centers in Moscow or the Moscow region, just do not tell me properly!

If anyone has a specific infa, please call 8-903-765-42-80

Doctors of the big city. Resuscitator

Education: graduated from the Military Medical Academy. SM Kirov, residency at the Department of Anesthesiology and Reanimatology of the Military Medical Academy. S. M. Kirov.

Job: Federal Medical and Biological Agency of the Russian Federation, private ambulance service; a volunteer doctor in the charitable program "Oxygen" and in other funds.

About work in the ambulance

There is such a book - "Revival without sensations"Albert Axelrod. It tells about the work of the resuscitator, from the beginning to the end of the shift. I got this book in the third grade, when I, on instructions of the teacher, helped to put things in order in the library. How this book turned out to be in school, I do not know. But she got me hooked. Then in the ninth grade for the deuce in mathematics I was kicked out of school. With my set of assessments, I could go only to a medical school: there was practically no competition. I became a paramedic, got to practice at the substation and somehow immediately got caught up with the resuscitators: we met the characters. I was young and, of course, I loved the ambulance. It happens to everyone who comes from the school: a big car with lighthouses, you rush to challenge - interesting. These doctors seemed almost gods: they saved people who were on the brink. At our substation there were special brigades for the whole city: cardioreanimation, neuroreanimation, brigade of special trauma. In difficult cases, when the linear brigade calls for help, the doctors of our substation were traveling. That is, I had an elite before my eyes.

Of course, as in any monastery, I passedRite of passage. First he tore up the car. The brigade arrived with a call - there is blood everywhere, torn packages from drugs. You take in hand a bucket with a solution of chloramine, a mop, a rag - and forward. The first month you just do the car. Then they allow something to be helped, something to be brought up. I think I was lucky that it happened in those days when doctors were not so tortured. I walked the tail and asked: "Why?" Nobody said to me: "Fall back, let me sleep. Go read it better in the textbook. " They sat down with me, laid out the ECG and asked: "What do you see here?" And so that I was not ashamed of the knowledge gaps, I read, prepared.

About the money in the intensive care unit

Department of resuscitation is one of the most expensive inhospital, besides, you never know how much money it will take. With cardiovascular or, say, infectious diseases, it can be more or less clear how much money will be spent on the patient, the OMS determines it. A person in this case receives a definite diagnosis and a certain set of drugs. In these offices not so often there will be something sudden, requiring huge expenses. But imagine: we bring a patient after an accident. We with traumatologists look, from what the patient will die the fastest. For example, you must first stop internal bleeding. We are trying to understand how much the brain is damaged, see if artificial ventilation is required. The cost of such events is great. It is often necessary to introduce an antibiotic (for example, "Meronem"), which is vital to the patient, because bacterial infections can develop very quickly. Its cost is 1 500-2 000 rubles for one bottle. It may happen that in two days it will be necessary to spend 16,000-20,000 rubles on this facility. And the OMC compensates our expenses only to 1,500 rubles per day. But the patient still needs blood products, he may need high-frequency ventilation (if there is bilateral damage to the chest), fixing the titanium structures (if we have fractures). It turns out that we are constantly in the red and spend drugs at the expense of other departments. I can not ask relatives to buy medicine.

In the interview. which was published in the "Russian reporter," Golikova said that in this case it is necessary to go to the head physician and get medication from him. But here you can imagine: an ordinary resuscitator comes to the head physician and says that he needs 30 thousand rubles a day for one patient (quite reasonable amount). At best, the head physician will call a psychiatrist and the head of the personnel department. In the worst case, without receiving medication, the resuscitator will have a lethal outcome in the department, as a result of which they will create a commission. She will determine that the doctor is to blame for the death of the patient. Then the doctors can be dismissed or the Investigative Committee will be engaged in it.

Department of resuscitation, or Why can not visit the seriously ill?

Are there any serious reasons not to let visitors into the "mysterious" department of resuscitation or is it simply reinsurance with.

Our expert - doctor-anesthesiologist of the branch № 6 of the Central military clinical hospital №3 named after. A. A. Vishnevsky Russian Defense Ministry, a member of the American Association of Anesthesiologists (ASA) Alexander Rabukhin .

Not only in the infection case

People, unfortunately, often faceThe situation when doctors are not allowed to visit their relatives in the intensive care unit. It seems to us: when a person is between life and death, it is very important for him to be with his family. Yes, and relatives want to see him, help him, encourage him, at least to alleviate his condition. It's no secret that nursing relatives can be much better than leaving nursing staff. It is believed that the reason for this prohibition is the fear of doctors that relatives can bring with them some kind of infection. Although it is difficult to imagine that people with an infection will seek to be in the intensive care unit to their relatives! It would seem, why the current Ministry of Health does not revise the instructions?

Doctors understand the emotions of people who are so hardsick relatives. But they insist that in such a serious matter as the question of life and death, one must be guided not only by emotions. If to speak objectively, then close relatives are often allowed into the intensive care unit. True, not for long and not in all cases. If you are refused, usually doctors have serious reasons for this. What kind?

First, the protection of the patient frominfection. Despite the fact that relatives are healthy and bring on themselves quite normal microflora, even it can be dangerous for a weakened, recently operated person or for a patient with a defect in immunity. And even if not for himself - then for his neighbors for resuscitation department.

The second reason, paradoxically as it sounds,- protection of visitors. After all, the patient himself can be a source of infection, and at times very dangerous. There are often severe viral pneumonia, and purulent infections. And the most important factor is the psychological protection of relatives. After all, most people have a bad idea of ​​what the department of resuscitation looks like. What we can see in a movie is very different from a real hospital, much like a war movie is different from real fighting.

... be I will live

Resuscitation patients often lie in a common room,without gender differences and without clothes. And this is not for "bullying" and not out of the disregard for staff, this is a necessity. In the state in which the patients most often fall into the intensive care unit, they do not care about "decency", here there is a struggle for life. But the psyche of an ordinary average visitor is not always ready to perceive such a kind of close person - with, say, six drains sticking out of the abdomen, plus a gastric tube, plus a catheter in the bladder, and an intubation tube in the throat.

I will quote a real case from my own practice: the husband begged him to go to his wife for a long time, and when he saw her in such a state, with the cry "But this thing prevents her from breathing!" he tried to pull the tube out of the trachea. Understand, the staff of the intensive care unit has something to do, except to look after the visitors - no matter how they began to correct the treatment or operation of the equipment themselves, or they would not collapse in stress.

It must also be taken into account that it will be very unpleasant for the relatives of other patients if their relatives are presented in this form before strangers.

Besides, believe me, in the overwhelming majoritycases of a patient resuscitation department is not to communicate with relatives, not to the "last words", and in general there is nothing. Resuscitation is not designed for visits, they are treated (or, at least, should be treated) until the last, while there is at least some hope. And no one should distract from this hard struggle neither doctors, nor patients, who need to mobilize all their forces in order to get out.

It seems to the family that the patient is in intensive careonly dreams of meeting with them, something to say to them, about something to ask. In the vast majority of cases, this is not so. If a person needs to be kept in the intensive care unit, he is most likely either unconscious (in a coma), or is on artificial ventilation or connected to other equipment. He can not and does not want to talk to anyone - because of the severity of his condition or under the influence of potent drugs.

As soon as the patient becomes better, he will be inconsciousness and will be able to communicate with relatives - it will certainly be transferred to a general office, where the relatives will have a wonderful opportunity instead of "good-bye" to say "hello." If there is no hope to "pull out" the patient anymore, if he dies from a severe chronic illness - for example, from oncology with numerous metastases or from chronic kidney failure, then such patients are not sent to the intensive care unit, they are given the opportunity to calmly and dignifiedly leave in the usual ward or at home, surrounded by relatives. Remember: if your relative is in intensive care, they struggle for his life to the end. and your presence can not always help him, but often can prevent doctors.

Of course, in such situations there are exceptions -and from a medical and a social point of view. And, if doctors find it possible, they will let their relatives go to the "reserved" department of resuscitation. And if not - show understanding and hope for the best.